Lessons from the Mental Health Act Commission for England and Wales: The Limitations of Legalism-Plus-Safeguards

2011 ◽  
Vol 41 (1) ◽  
pp. 61-81 ◽  
Author(s):  
DAVID PILGRIM
Keyword(s):  
Mental Health ◽  
Risk Taking ◽  
Mental Health Problems ◽  
Group Membership ◽  
Social Forces ◽  
Differential Impact ◽  
Age And Gender ◽  
England And Wales ◽  
Mental Health Act ◽  
And Gender

AbstractIn 2009, the Mental Health Act Commission for England and Wales was closed down and its functions subsumed in separate organisations in the two countries. Its final biennial report, issued that year, focused on coercion and consent. This article uses some aspects of the report to discuss the implications of lawful psychiatric coercion being predicted by social group membership (correlated with race, age and gender). The work of the Commission furnished useful information in this regard, but its framework for data collection could not, and so did not, illuminate a more established picture of the class gradient in mental health problems. With the latter literature in mind, material adversity may explain the racial patterning of psychiatric populations coercively detained. However, normative aspects of risk-taking in the community and in hospital may better predict the findings on age and gender. The article concludes by querying the ameliorative impact of government appointed ‘visitorial’ bodies. Legalism-plus-safeguards is a questionable basis for meaningfully bringing discriminatory powers to book, or for reversing the differential impact of pathogenic social forces.

scholarly journals Repeated Police Mental Health Act Detentions in England and Wales: Trauma and Recurrent Suicidality

2019 ◽  
Vol 16 (23) ◽  
pp. 4786
Author(s):  
Claire Warrington
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Mental Health Problems ◽  
Police Intervention ◽  
England And Wales ◽  
Mental Health Act ◽  
Self Harm ◽  
South East England ◽  
National Police

Most police Mental Health Act (Section 136) detentions in England and Wales relate to suicide prevention. Despite attempts to reduce detention rates, numbers have risen almost continually. Although Section 136 has been subject to much academic and public policy scrutiny, the topic of individuals being detained on multiple occasions remains under-researched and thus poorly understood. A mixed methods study combined six in-depth interviews with people who had experienced numerous suicidal crises and police intervention, with detailed police and mental health records. A national police survey provided wider context. Consultants with lived experience of complex mental health problems jointly analysed interviews. Repeated detention is a nationally recognised issue. In South East England, it almost exclusively relates to suicide or self-harm and accounts for a third of all detentions. Females are detained with the highest frequencies. The qualitative accounts revealed complex histories of unresolved trauma that had catastrophically damaged interviewee’s relational foundations, rendering them disenfranchised from services and consigned to relying on police intervention in repeated suicidal crises. A model is proposed that offers a way to conceptualise the phenomenon of repeated detention, highlighting that long-term solutions to sustain change are imperative, as reactive-only responses can perpetuate crisis cycles.

scholarly journals Hospital admissions for stress-related presentations among school-aged adolescents during term time versus holidays in England: weekly time series and retrospective cross-sectional analysis

BJPsych Open ◽  
2021 ◽  
Vol 7 (6) ◽  
Author(s):  
Ruth Blackburn ◽  
Omotomilola Ajetunmobi ◽  
Louise Mc Grath-Lone ◽  
Pia Hardelid ◽  
Roz Shafran ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Admission ◽  
Incidence Rate ◽  
Cumulative Incidence ◽  
Mental Health Problems ◽  
Hospital Admissions ◽  
Age And Gender ◽  
Self Harm ◽  
And Gender ◽  
Rate Ratios

Background Schools are a potential stressor for adolescents and may contribute to emergency hospital admissions. Aims We describe rates of stress-related presentations (SRPs) among school-aged adolescents (11–17 years) during school terms and holidays, and explore differences by age and gender. Method Using national administrative hospital data, we defined an SRP as an emergency hospital admission with a primary diagnosis related to pain, psychosomatic symptoms (e.g. fatigue) or mental health problems, or with self-harm indicated in any diagnostic position. We estimated incidence rate ratios for weekly SRPs in term time versus holidays from 2014–2015 to 2017–2018, using negative binomial regression models, stratified by age and gender. We estimated the cumulative incidence of any SRP between 11 and 17 years by analysing prior hospital admission histories of adolescents with an SRP in 2017–2018. Results Over the 4-year study period, 305 491 SRPs in 171 013 school-aged adolescents accounted for 31% of emergency admissions for this group. SRPs were predominantly for mental health problems or self-harm (38%), or pain (35%). Weekly admission rates for SRPs were higher in term time than holidays for all ages (age-specific incidence rate ratios were 1.15–1.49 for girls and 1.08–1.60 for boys). Rates were highest for girls aged 14 and 15 years. The estimated cumulative incidence of any SRP between 11 and 17 years was 7.9% for girls and 4.1% for boys. Conclusions Hospital admissions for SRPs are common among adolescents, affecting around two girls and one boy in every classroom. Higher rates in term time than holidays suggest that school factors may contribute.

scholarly journals Exhausted due to the pandemic: Validation of Coronavirus Stress Measure and COVID-19 Burnout Scale in a Polish sample

2021 ◽  
Author(s):  
Marcin Moroń ◽  
Murat Yildirim ◽  
Łukasz Jach ◽  
Justyna Nowakowska ◽  
Karina Atlas
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Internal Consistency Reliability ◽  
Factor Solution ◽  
Age And Gender ◽  
Confirmatory Factor ◽  
Stress Measure ◽  
High Internal Consistency ◽  
And Gender ◽  
High Internal Consistency Reliability

AbstractThis study validated Polish versions of the Coronavirus Stress Measure (CSM) and the COVID-19 Burnout Scale (COVID-19-BS) to measure stress and burnout associated with COVID-19. Participants were 431 Polish young adults (72.6% female; Meanage = 26.61 ± 12.63). Confirmatory factor analysis verified a one-factor solution for both the CSM and the COVID-19-BS. Both scales had high internal consistency reliability. Coronavirus stress and COVID-19 burnout were positively related to depression, anxiety, and stress and negatively related to resilience. The coronavirus stress and COVID-19 burnout were correlated with elevated levels of depression, anxiety, and stress over and beyond resilience, age, and gender. Findings suggest that the Polish versions of the CSM and the COVID-19-BS are valid scales to measure stress and burnout related to COVID-19. Findings also demonstrated that the coronavirus stress and COVID-19 burnout experienced during the later stages of the pandemic might be a permanent risk factor for mental health problems.

scholarly journals Repeated Police Mental Health Act Detentions in England and Wales: Trauma and Recurrent Suicidality

2019 ◽  
Author(s):  
Claire Warrington
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Mental Health Problems ◽  
Police Intervention ◽  
England And Wales ◽  
Mental Health Act ◽  
Self Harm ◽  
South East England ◽  
National Police

Most police Mental Health Act (Section 136) detentions in England and Wales relate to suicide prevention. Despite attempts to reduce detention rates, numbers have risen almost continually. Although Section 136 has been subject to much academic and public policy scrutiny, the topic of individuals being detained on multiple occasions remains under-researched and thus poorly understood. A mixed methods study combined six in-depth interviews with people who had experienced numerous suicidal crises and police intervention, with detailed police and mental health records. A national police survey provided wider context. Consultants with lived experience of complex mental health problems jointly analysed interviews. Repeated detention is a nationally recognised issue. In South East England it almost exclusively relates to suicide or self-harm and accounts for a third of all detentions. Females are detained with the highest frequencies. The qualitative accounts revealed complex histories of unresolved trauma that had catastrophically damaged interviewee’s relational foundations, rendering them disenfranchised from services and consigned to relying on police intervention in repeated suicidal crises. A model is proposed that offers a way to conceptualise the phenomenon of repeated detention, highlighting that long-term solutions to sustain change are imperative, as reactive-only responses can perpetuate crisis cycles.

The Mental Health Act 1983

2017 ◽  
Vol 10 (11) ◽  
pp. 638-643
Author(s):  
Jonathan Mills ◽  
Jaspreet Phull
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Problems ◽  
Legal Framework ◽  
Health Problems ◽  
Practical Application ◽  
England And Wales ◽  
Mental Health Act ◽  
Consent To Treatment ◽  
Insight Into

Mental health problems constitute a significant demand on the caseload of GPs. Although most patients can be managed with joint understanding and agreement as to treatment, GPs will encounter patients deemed to have mental illness of such severity that the patients’ ability to consent to treatment, admission or ongoing management in the community is brought into question. Patients may refuse necessary treatment, or lack insight into their condition and the necessary treatment. The patient may not accept that they are unwell. This can put great demands on caregivers and also requires knowledge of the legal framework necessary to ensure treatment of patients safely, legally and ethically. This article aims to outline the Mental Health Act 1983 as it applies in England and Wales, and to give advice on its practical application.

scholarly journals Effects of severe mental illness on survival of people with diabetes

2010 ◽  
Vol 197 (4) ◽  
pp. 272-277 ◽  
Author(s):  
Yana Vinogradova ◽  
Carol Coupland ◽  
Julia Hippisley-Cox ◽  
Seán Whyte ◽  
Catherine Penny
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Mental Health Problems ◽  
Survival Rates ◽  
The Other ◽  
Age And Gender ◽  
Risk Of Death ◽  
Hazard Ratios ◽  
Increased Risk ◽  
And Gender

BackgroundPeople with mental health problems are more likely to die prematurely than the general population but no study has examined this in individuals with diabetes.AimsTo compare survival rates in people with diabetes with and without schizophrenia or bipolar disorder.MethodA total of 43 992 people with diabetes were drawn from the QRESEARCH database population of over 9 million patients. Survival rates during the study period, between 1 April 2000 and 1 April 2005, and hazard ratios for deaths associated with schizophrenia and bipolar disorder were adjusted by age and gender and additionally for socioeconomic status, obesity, smoking and use of statins.ResultsAmong the participants, we identified 257 people diagnosed with schizophrenia, 159 with bipolar disorder and 14 with both conditions. Although crude survival rates did not show significant differences between the groups during the study period, people with schizophrenia or bipolar disorder and diabetes, compared with those with diabetes alone, had a significantly increased risk of death after adjusting for age and gender, with hazard ratios for schizophrenia of 1.84 (95% CI 1.42–2.40) and for bipolar disorder of 1.51 (95% CI 1.10–2.07). After adjusting for the other factors, hazard ratios were 1.52 (95 CI 1.17–1.97) for schizophrenia and 1.47 (95% CI 1.07–2.02) for bipolar disorder.ConclusionsPeople with schizophrenia or bipolar disorder in addition to diabetes have a relatively higher mortality rate. This suggests that diabetes either progresses more rapidly or is more poorly controlled in these individuals, or that they have higher levels of comorbidity and so are more likely to die of other causes.

scholarly journals Rise in the use of section 136 of the Mental Health Act 1983 in England and Wales: A viewpoint on Loughran (2018)

2019 ◽  
Vol 60 (2) ◽  
pp. 140-146 ◽  
Author(s):  
Mark Cresswell
Keyword(s):  
Mental Health ◽  
Recent Work ◽  
Theoretical Perspective ◽  
Causal Analysis ◽  
England And Wales ◽  
Mental Health Act ◽  
The Law

This article provides a critical viewpoint on Loughran’s recent work in Medicine, Science and the Law on the causes of the rise in the police’s use of section 136 (s136) of the Mental Health Act 1983 (Loughran M. Detention under section 136: why is it increasing? Med Sci Law 2018; 58: 268–274). The rate of this rise seems significant: by 2014, it was five times more likely that a person in England would be detained in a hospital under s136 than it was in 2000, and the trend has continued to the present day. This viewpoint considers the significance of the s136 rise from the theoretical perspective of causal analysis.

scholarly journals Social determinants of depression: association with age, gender and primary health care model

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J China
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Social Determinants ◽  
Care Physician ◽  
Health Policies ◽  
Age And Gender ◽  
Primary Health ◽  
And Gender ◽  
Primary Health Care Physician

Abstract Background Depression is one of the most common mental disorders worldwide and is a major contributor to the overall global burden of disease. The social determinants of age, gender and access to a primary health care physician have been identified as significant determinants of variability in the prevalence of depression. This research evaluates the association between depression and these social determinants in the city of Almada, in Portugal. Methods This cross-sectional study reports the one-month prevalence (December, 2015) of depression and its association with age, gender and access to a primary health care doctor in Almada's primary health care population. Data was collected from the 'Information System of the Regional Health Administration' (SIARS) database. The diagnostic tools used for the identification of cases were the ICPC-2 codes 'P76: Depressive Disorder' and 'P03: Feeling Depressed'. An odds ratio was applied as an association measure. Results Regarding gender and age: women are more likely to develop depression than men (OR 3.21) and the age group of 40-64 years is more likely to develop depression compared with other age groups (OR 2.21). The odds of being affected by depression for patients with a permanent primary health care physician, compared with users without a permanent primary health care physician, are higher (OR 2.24). Conclusions The patterns of association of age and gender, uncovered in this dataset, are consistent with previously reported findings for other Western countries. The association between depression and the assignment of a permanent primary health care doctor is highly significant. This finding suggests the existence of a higher detection rate of depression in patients with a permanent doctor and adds weight to the need to implement health policies that guarantee a primary health care physician for each patient. Key messages The age and gender gap in depression calls for stronger public health and intersectoral strategies to promote and protect mental health, in community-based settings. Reducing barriers and enhancing access to high-quality primary medical care must be a cornerstone of mental health policies.

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